Some of us may already know that Americans aren’t as healthy as other nations. We try to do our best, but the well-known culprits that bring us down run rampant in our culture, such as the less-than-stellar American diet and other lifestyle factors, like alcohol consumption, smoking, and lack of activity. We also seem to experience more stress and greater difficulties in managing it. For a lot of us, this is just the life we live, a part of our culture. All of these factors can contribute to greater rates of heart attacks, higher cholesterol and sugar levels, and obesity – disease states that are often regarded as the classic hallmarks of American morbidity. None of this information is necessarily new, but a recent study regarding life expectancy in the U.S. and abroad is suggesting something even more alarming.
In fact, the study didn’t exactly say that Americans aren’t healthy; it actually revealed a more dismal statistic that we – as a nation – are dying younger. Not only are we are experiencing a shorter life span compared to 18 other high-income nations, we actually ranked last and are projected to keep falling further and further behind other countries like Germany, France, and Sweden. What’s more astonishing is that the study found that death in the U.S. is happening more frequently at younger ages (ages 0 to 65), while other nations are experiencing the more “typical” death, that of which is more closely linked to old age. What exactly is killing us, and why are other nations doing better?
It is definitely concerning to see decreases in life expectancies, especially in the absence of major war or substantial economic reform. In a high-income nation like ours with access to vaccines, medications, clean food and water, and many lifestyle interventions – not to mention the billions we spend on healthcare annually – we should expect life expectancies to be going up, or at least staying stagnant. But this is not what the study is showing. While we no longer have to worry about the plague or other crippling diseases, perhaps we now have new epidemics in the U.S. to explain these poor statistics – and it’s not the American diet.
The study hypothesized two theories to explain shorter life expectancies, and it may or may not be what you think. Their first theory is the influenza virus. We have been experiencing more crippling flu seasons than ever before, and acute illnesses in the form of pneumonia, the flu, and other respiratory issues are taking more lives than most of us could foresee. The second theory explaining decreasing life spans is perhaps more pronounced: the opioid epidemic. The study states that “Drug overdose was a key contributor in the USA—this cause alone was responsible for nearly a fifth of the decline in life expectancy for American women during 2014-15.”
So what can Americans do about our new “epidemics”? The answer is difficult. Ben Franklin once said, “An ounce of prevention is worth a pound of cure.” The good news is that the illnesses that are killing Americans are highly preventable. The bad news is that we are still figuring out how to prevent them. We have the influenza and pneumococcal vaccinations, plus excellent standards of care for respiratory issues, but the opioid epidemic has proven to be much more difficult to keep at bay. For any of us who have experienced substance abuse firsthand, the trials of overcoming addiction are formidable, to say the least. Growing up in a fairly well-off suburban town, on the outskirts of a major city, I know of quite a few people whose lives been taken and families left in shambles.
The opioid epidemic hasn’t gone unnoticed at the federal level, with excessive opioid prescribing being a key contributor in abuse and overdose. In fact, everything is on “crackdown,” for lack of better words. Clinicians need to rigorously make sure an opioid pain medication is even needed (in many cases, mandated lowering of an opioid drug is occurring) and pharmacists everywhere are taking extra steps to verify the validity and necessity of all controlled scripts. This is a difficult undertaking, because there are many patients who legitimately need opioid-derived medications to control pain. In fact, judicious use of opioids has proven more benefit than harm in many cases. Aside from a clinical setting, pharmaceutical companies are coming up with new, abuse-deterrent formulations of medications like oxycodone, hydrocode, and morphine. The science and technology that has been utilized in formulating these drugs is unbelievable. They can no longer be crushed, snorted, or injected for rapid absorption.
But is micro-managing the opioid crisis working? Some data says it is, and other research says it isn’t. We know that when we take something away, another option occurs. This rationale is exactly what a new study is suggesting, showing evidence of the new abuse-deterrent oxycodone possibly spurring higher heroin usage. We also now have legalized marijuana in many states and other classic medications, like anti-anxiety drugs and muscle relaxants that are often used in combinations to get “high.” Fixing the root of the problem is difficult when we’re not quite sure where the root lies.
I don’t exactly know what the solutions to the opioid epidemic are either, but there has to be a good reason why other nations aren’t as crippled by it as we are. When it is taking more lives than war itself, we might need a few different approaches to fight it. I do know that investing in our youth through drug education programs can’t hurt. As a mom, it is something I worry about with my own children often and will do my absolute best to safeguard them. But as a clinician, I know that pain needs to be treated appropriately and effectively, and all I can do is my best in these cases, as well.
References:
Ho Jessica Y, Hendi Arun S. Recent trends in life expectancy across high income countries: retrospective observational study BMJ 2018; 362 :k2562
Did Abuse-Deterrent Oxy Spur Higher Heroin Usage–and Hepatitis C Rates? – Medscape – Feb 06, 2019.
